This week’s Morphology Monday case was from an 80 something year old male who presented with:

• Fatigue
• Weight loss
• Early satiety

The patient’s FBC results showed:

• WBC: 330.2 ×10⁹/L
• Leucocytosis with neutrophilia, basophilia, eosinophilia and nucleated red blood cells (NRBCs).
• Left shift, immature granulocyte and blast flags on the analyser.
• Mild anaemia and macrocytosis.

Peripheral blood film images

The blood film images show increased granulocytes with myelocytes, metamyelocytes, mature cells and also the occasional blast. There are eosinophils and basophils also present. A markedly raised WBY with a full spectrum of myeloid precursors, and increased basophils should raise a strong suspicion of CML. CML is a myeloproliferative neoplasm driven by the BCR:ABL1 fusion gene, the presence of which can be confirmed by molecular or cytogenetic studies.